As number of people reaching old age increases, the number of incidences of Alzheimer’s is increasing as well. There are many factors associated with the progression of Alzheimer’s both physically and cognitively; and treating these patients can be complex.
Objectives
The reader will understand what Alzheimer’s Disease is.
The reader will understand the diagnosis process of Alzheimer’s Disease
The reader will recognize the Stages of Alzheimer’s Disease
The reader will recognize important aspects of examination for patients with Alzheimer’s Disease
Provide examples of objective assessments to use with an examination
The reader will understand basic treatment areas for patients with Alzheimer’s Disease
Provide resources on Alzheimer’s Disease
What is Alzheimer's Disease
Alzheimer’s Disease is a chronic, irreversible type of dementia. It affects 1.5-2.3 million people in the United States, and accounts for 55-70% of adult-onset dementia and is the 5th leading cause of death is the US for people over 65. It causes a gradual decline in memory and cognitive functions in an older adult over time. It begins with a subtle onset of mild cognitive decline and progresses to a debilitation state. Areas of cognition that are mostly affected are recent memory, orientation, and retrospective loss of remote function. It causes a physical decline in the later stages, causing complete dependence on a caregiver for all functioning.
The medical diagnosis of Alzheimer’s disease is based on exclusion of other explanations for the physical and cognitive decline in patients. A common finding in patients with Alzheimer’s Disease are amayloid Plaques and nuerofibillary tangles in the brain through MRI scans. These findings along with the associated cognitive declines over a period of time lead to a diagnosis. A true diagnosis of Alzheimer's Disease occurs after death upon autopsy analysis of the person's brain.
Stages of Alzheimer’s Disease
Alzheimer’s Disease is staged based on the progression of decline within an individual. Most people go through the stages, however the pace of decline varies between individuals.
Changes in thinking are rarely detected by friends, family, or medical personnel
Stage 3 – Early Confusional/Mild Cognitive Impairment.
Subtle difficulties begin to impact function.
They may consciously or subconsciously try to cover up his or her problems.
Difficulty with retrieving words, planning, organization, misplacing objects, and forgetting recent learning, which can affect life at home and work.
Depression and other changes in mood can also occur.
Duration: 2 to 7 years.
Stage 4 – Late Confusional/Mild Alzheimer’s.
Problems handling finances result from mathematical challenges.
Increasingly forget recent memories and conversations.
Still know themselves and their family.
Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping.
Begin to withdraw from social situations, become defensive, and deny problems.
Accurate diagnosis of Alzheimer’s disease is possible at this stage.
Lasts roughly 2 years.
Stage 5 – Early Dementia/Moderate Alzheimer’s disease.
Decline is more severe and requires assistance.
No longer able to manage independently or recall personal history details and contact information.
Frequently disoriented regarding place and or time.
Severe decline in numerical abilities and judgment skills.
Basic daily living tasks like eating and dressing require increased supervision.
Duration: an average of 1.5 years
Stage 6 – Middle Dementia/Moderately Severe Alzheimer’s disease.
Total lack of awareness of present events and inability to accurately remember the past.
Progressive loss of the ability to take care of daily living activities like dressing, toileting, and eating
Still able to respond to nonverbal stimuli, and communicate pleasure and pain through behavior.
Agitation and hallucinations often show up in the late afternoon or evening.
Dramatic personality changes such as wandering or suspicion of family members are common.
Can't remember close family members, but know they are familiar.
Lasts approximately 2.5 years.
Stage 7 – Late or Severe Dementia and Failure to Thrive.
Speech and the ability to walk or sit becomes severely limited.
Total support around the clock is needed for all functions of daily living and care.
Duration is impacted by quality of care
Average length is 1 to 2.5 years.
Examination areas
Due to the cognitive and physical changes that take place during the disease progression, people with Alzheimer’s disease are susceptible to falls and physical injuries that can drastically change their health status. According to Geriatric Rehabilitation, A Clinical Approach, there are 6 main areas to examine is these patients.
Other areas to include in an examination are range of motion, strength, gait, balance, transfers, and visual difficulties. These can all affect the person’s ability to function independently. Below are suggested objective measurements that can be used for this patient population.
Possible Objective Assessments
Cognitive – Minin Mental State Exam, Short Portable Mental Status Questionaire, 7-Minute Screen, Clock Drawing
Treatment Areas
The main goal of treatment is for the patient to maintain the highest level of function possible. There is no cure for Alzheimer’s Disease however, physical therapy and consistent exercise can assist in maintaining functional abilities for as long as possible. Exercise can have many affects on the body both physically and mentally in Alzheimer's Disease. Patient's with Alzheimer's disease should exercise for at least 30 minutes a day 3-5 days per week.
Exercise areas to focus on
Strength - weights and body weight strengthening exercises
Endurance - walking program
Balance - static and dynamic balance challenges
Flexibility - stretching
Other aspects to incorporate into treatment are including cognitive tasks and validation tasks (folding laundry, cleaning the kitchen counter). These, along with exercise helps to slow the progression of cognitive deficits as well as give the patient a sense of validation in their daily life. It is important to incorporate functional tasks into treatment with these patient's because the main goals of exercise are to maintain functional abilities for as long as possible. Patient's with Alzheimer's Disease will also be on many medications to counter the effects of the disease itself. It is important to know which medications they are on and any side effects or interaction effects that they may have.
Caregiver education is also an important aspect of treatment. As the disease progresses, the patient increasingly relies more on caregivers for daily activities including dressing, bathing, toileting, feeding, as well as any other daily activities that need to be completed. Education on home modifications should be given to decrease the risk of falls associated with decreases in strength, balance, and gait associated with Alzheimer's Disease. Caregivers must be educated on proper techniques for transfers, daily care, as well as resources for support groups and respite care. It is important for the caregiver to receive support.
Houghs, Juliane. Alzheimer's and Other Dementias. Oxford: Oxford UP, 2011. Print.
Budson, Andrew E. The Handbook of Alzheimer's Disease and Other Dementias. Chichester, West Sussex, UK: Wiley-Blackwell, 2011. Print.
Bottomley, Jennifer M., and Carole Bernstein Lewis. Geriatric Rehabilitation: A Clinical Approach. 3rd ed. Upper Saddle River, N.J.: Pearson/Prentice Hall, 2008. 309-312. Print.
Terri, Linda, McCurry Susan, David Buchner, and Rebecca Logsdon. "Exercise and Activity Level in Alzheimer's Disease: A Potential Treatment Focus." Journal of Rehabilitation, Research, and Development 35.4 (1998): 411-19.
Farina, Nicolas, Jennifer Rusted, and Naji Tabet. "The Effect of Exercise Interventions on Cognitive Outcome In Alzheimer’s Disease: A Systematic Review." International Psychogeriatric 26.1 (2014): 9-18. Print
Objectives
What is Alzheimer's Disease
Alzheimer’s Disease is a chronic, irreversible type of dementia. It affects 1.5-2.3 million people in the United States, and accounts for 55-70% of adult-onset dementia and is the 5th leading cause of death is the US for people over 65. It causes a gradual decline in memory and cognitive functions in an older adult over time. It begins with a subtle onset of mild cognitive decline and progresses to a debilitation state. Areas of cognition that are mostly affected are recent memory, orientation, and retrospective loss of remote function. It causes a physical decline in the later stages, causing complete dependence on a caregiver for all functioning.
The medical diagnosis of Alzheimer’s disease is based on exclusion of other explanations for the physical and cognitive decline in patients. A common finding in patients with Alzheimer’s Disease are amayloid Plaques and nuerofibillary tangles in the brain through MRI scans. These findings along with the associated cognitive declines over a period of time lead to a diagnosis. A true diagnosis of Alzheimer's Disease occurs after death upon autopsy analysis of the person's brain.
Stages of Alzheimer’s Disease
Alzheimer’s Disease is staged based on the progression of decline within an individual. Most people go through the stages, however the pace of decline varies between individuals.
Examination areas
Due to the cognitive and physical changes that take place during the disease progression, people with Alzheimer’s disease are susceptible to falls and physical injuries that can drastically change their health status. According to Geriatric Rehabilitation, A Clinical Approach, there are 6 main areas to examine is these patients.
Other areas to include in an examination are range of motion, strength, gait, balance, transfers, and visual difficulties. These can all affect the person’s ability to function independently. Below are suggested objective measurements that can be used for this patient population.
Possible Objective Assessments
Treatment Areas
The main goal of treatment is for the patient to maintain the highest level of function possible. There is no cure for Alzheimer’s Disease however, physical therapy and consistent exercise can assist in maintaining functional abilities for as long as possible. Exercise can have many affects on the body both physically and mentally in Alzheimer's Disease. Patient's with Alzheimer's disease should exercise for at least 30 minutes a day 3-5 days per week.
Exercise areas to focus on
Other aspects to incorporate into treatment are including cognitive tasks and validation tasks (folding laundry, cleaning the kitchen counter). These, along with exercise helps to slow the progression of cognitive deficits as well as give the patient a sense of validation in their daily life. It is important to incorporate functional tasks into treatment with these patient's because the main goals of exercise are to maintain functional abilities for as long as possible. Patient's with Alzheimer's Disease will also be on many medications to counter the effects of the disease itself. It is important to know which medications they are on and any side effects or interaction effects that they may have.
Caregiver education is also an important aspect of treatment. As the disease progresses, the patient increasingly relies more on caregivers for daily activities including dressing, bathing, toileting, feeding, as well as any other daily activities that need to be completed. Education on home modifications should be given to decrease the risk of falls associated with decreases in strength, balance, and gait associated with Alzheimer's Disease. Caregivers must be educated on proper techniques for transfers, daily care, as well as resources for support groups and respite care. It is important for the caregiver to receive support.
Resources
References